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STATE OF CALIFI +IA DEPARTMENT OF PEST( REGULATION <br /> MONTHLY SUMMARY PESTICIDE USE REPORT ENFO RENT BRANCH <br /> PR-ENF-060(REV.08108)Page 1 of 6 <br /> INSTRUCTIONS FOR COMPLETING THIS FORM ARE INDICATED BELOW AND ON THE REVERSE SIDE <br /> OPE OR(FIRM NAME) ADDRESS CITY ZIP CODE PHONE NUMBER <br /> e r /� �? a 1. / iii �s �2�' .369'51�� <br /> OPERATOR IDIPERMIT NUMBER LICENSE NUMBER COUNTY CO <br /> HERE APPLIED UNTY NUMBER MONTH/YEAR OF USE TOTAL NUMBER 0=APPLICATIONS <br /> 1. Complete Columns A,B, C,and D for All Use s <br /> 2.Complete Column E by using one of the following codes: <br /> Code 10 Structural Pest Control.....................................includes any pest control work performed within or on buildings and other structures. <br /> Code 30 Landscape Maintenance Pest Control.............includes any pest control work performed on landscape plantings around residences or other buildings,golf courses,parks,cemeteries,etc. <br /> Code 40 Right-of-Way Pest Control...............................includes any pest control work performed along roadsides,power lines,median strips,ditch banks,and similar sites. <br /> Code 50 Public Health Pest Control...............................includes any pest control work performed by or under contract with State or local public health or vector control agencies. <br /> Code 80 Vertebrate Pest Control....................................includes any vertebrate pest control work performed by public agencies or work under the supervision of the State or county agricultural commissioner. <br /> Code 91 Commodity Fumigation(Nonfood/Nonfeed).....includes fumigation of nonfood/nonfeed commodities such as pallets,dunnage,furniture,burlap bags,etc. <br /> Code 100 Regulatory Pest Control.................................includes any pest control work performed by public employees or contractors in the control of regulated pests. <br /> 3. Complete Columns F and G,if use does nQ fit one of the above codes <br /> A B C D E F G <br /> MANUFACTURER AND EPA/CALIFORNIA REGISTRATION NUMBER FROM LABEL TOTAL PRODUCT USED NUMBER OF CODE COMMODITY OR SITE ACRESIUNITS TREATED <br /> NAME OF PRODUCT APPLIED INCLUDE ALPHA CODE (Circle One Unit of Measure) APPLICATIONS TREATED <br /> (/ lid l G 160 - <br /> YA Lk Z f IV L 7 7 OZ PT QT GA <br /> ' © U LB OZ PT 0T G <br /> G� 1 LB OZ PT QT GA <br /> 11 /� <br /> 5 � 7 6 6�./ LB OZ PT QT G /f (1� <br /> Q <br /> LB OZ PT QT GA a <br /> 05 <br /> 900] LB OZ PT QT GA <br /> ,9rs O5 LB OZ PT QT GA tJ• -' <br /> l <br /> LB OZ PT QT GA <br /> LB OZ PT QT GA <br /> LB OZ PT QT GA <br /> REPORT PREPARED BY ` DATE , <br />